Infection Prevention Resources

Overview

Isolation precautions are used to reduce transmission of microorganisms in healthcare and residential settings. These measures are designed to protect patients/residents, staff, and visitors from contact with infectious agents. There are two categories of isolation precautions: standard precautions and transmission-based precautions.  In 2007, the Healthcare Infection Control Practices Advisory Committee (HICPAC) published recommendations to for how and when to apply standard and transmission-based precautions in healthcare settings, including a table of selected infections/conditions and the type and duration of precautions that are recommended.

Infection prevention strategies are geared toward breaking the “chain of infection” or “chain of transmission" . In order for an infection to occur, each link of the chain must be connected. Breaking any link of the chain can stop the transmission of infection.

The six links of the chain of infection are:

  • Infectious disease (any microorganism such as a bacterium or virus that can cause disease)
  • Reservoir (place where an infectious disease lives, thrives, and reproduces)
  • Portal of exit (place where the organism leaves the reservoir)
  • Mode of transmission (how an infectious disease transfers from one person or object to another person)
  • Portal of entry (place where the infectious disease enters the body of a susceptible host)
  • Susceptible host (a person at risk for developing an infection)

In healthcare facilities, it is also important to create a culture of safety and to encourage effective communication between healthcare providers, patients, and family members to help prevent infection. Partnering to Heal is a computer-based, video-simulation training program developed by the Department of Health and Human Services that highlights these themes of communication and creation of a patient safety culture. Users assume the identity of one of five main characters and make decisions about preventing HAIs in the hospital setting.


Standard precautions are a set of basic infection prevention practices intended to prevent transmission of infectious diseases from one person to another.  Because we do not always know if a person has an infectious disease, standard precautions are applied to every person every time to assure that transmission of disease does not occur. These precautions were formerly known as “universal precautions.”
Standard precautions include

Hand hygiene

Hand hygiene involves cleaning hands with soap and water or an alcohol-based hand rub to prevent transmission of  germs  to others.

Clean hands are the most important factor in preventing the spread of disease and antibiotic resistance in settings across the continuum of health care.

Hand hygiene is a general term that refers to a method of removing microorganisms from the hands so the germs cannot be transmitted to anyone else. The two most common types of hand hygiene are hand washing with soap and water and using an alcohol-based hand rub. Perform hand hygiene before and after patient/resident contact; after contact with objects or surfaces in the patient/resident’s immediate vicinity; and after removing gloves (if worn).

  • Soap and water should be used when hands are visibly dirty, contaminated, or soiledafter using the restroom, and before eating or preparing food.  Washing hands with soap and water is also recommended to prevent the spread of certain organisms (such as Clostridium difficile).
  • Alcohol-based hand rubs are products that kill germs on the hands. They are fast-acting, convenient, and generally can be used for all situations other than the ones described above.  Be sure to use hand rubs that contain 60-95% ethanol or isopropanol (types of alcohol).

Hand hygiene is part of standard precautions because it is a prevention measure that should be applied to all patients in all settingsall the time.

Patients can take action by asking both their healthcare providers and visitors to practice appropriate hand hygiene.

General Websites

Fact Sheets and Brochures

Guidelines

In-services and Presentations

Other Tools and Toolkits

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Personal protective equipment

Personal protective equipment consists of certain types of clothing or equipment that a person wears to protect his/her body from injury and infection

  • Face mask/face shield/eye protection (goggles)
    • Worn if contact with blood or body fluids may occur, especially during suctioning and intubation.
  • Gloves
    • Worn if contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated items in the patient/resident’s environment may occur.
  • Gown
    • Worn if contact with blood or body fluids may occur.

Resources

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Patient/resident care equipment

  • Handle in a manner that prevents transfer of germs to others and to the environment.
  • Wear gloves if equipment is visibly contaminated.
  • Perform hand hygiene.

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Cleaning of the environment

Overview

In healthcare settings, microorganisms (bacteria, fungi, viruses) are present throughout the environment and can cause infection. The environment can serve as a breeding ground for these organisms. Cleaning and disinfecting surfaces and medical equipment, especially those that are frequently touched, is important to decrease and prevent the spread of these organisms to people.

It is important to develop procedures for routine care, cleaning, and disinfection of environmental surfaces, especially frequently touched surfaces in patient/resident-care areas.


 
Important Environmental Cleaning Terms

Cleaning = removal of all visible dust, soil, and any other foreign material

Decontamination = removal of disease-producing microbes to make safe for handling

Disinfection = process that destroys nearly all disease-producing organisms, except spores

  • Involves the use of a chemical or physical agent called a disinfectant
  • Classified as high-level, intermediate-level, or low-level
  • Cannot disinfect without cleaning first

Sterilization = process that destroys microorganisms and spores

  • Involves the use of a physical process such as steam and pressure, dry heat, or a chemical process

For Healthcare Providers

General tips on cleaning and disinfection:

  1. Only use disinfectants registered with the U.S. Environmental Protection Agency (EPA).
  2. Directions for cleaners and disinfectants should be reviewed for use, dilution, contact time, and shelf life.
    1. Contact time: amount of time needed for the chemical to come in contact with the microorganism so that a significant number of organisms are killed.
  3. Housekeeping surfaces (e.g., floors, table tops) and other environmental surfaces should be cleaned and disinfected regularly, when spills occur, and when visibly dirty. Medical equipment that is shared should be cleaned and disinfected between patients. Follow your facility’s schedule for routine cleaning and disinfection and for terminal cleaning of rooms when preparing the room for the next patient.
  4. Use a disinfectant appropriate for the situation.
    1. For example: C. difficile and norovirus contaminated areas may need different cleaners and disinfectants
  5. How to prepare a solution using household bleach (5.25%-6.15% hypochlorite):
    1. 1:10 dilution
      1. 1 part bleach to 9 parts water
      2. 1 ½ cups bleach in 1 gallon water
      3. Example of when this dilution is recommended: for routine environmental disinfection in units with high rates of endemic Clostridium difficile infection or in a Clostridium difficile outbreak setting
    2. 1:100 dilution
      1. 1 part bleach to 99 parts water
      2.  1/4 cup bleach in 1 gallon water
      3. Example of when this dilution is recommended: for cleaning small blood spills (i.e. a few drops of blood)

Different types of equipment and environmental surfaces need different levels of cleaning, disinfection, or sterilization depending on the use of the item/surface and the risk of becoming infected with germs that may be on the item/surface.

1) Critical items are items that enter normally sterile tissue or the vascular system or through which a sterile body fluid (e.g., blood) flows. These items are associated with high risk of infection if they are contaminated with any microorganism and must be sterilized before using. Examples include surgical instruments, cardiac and urinary catheters, and implants.

2) Semicritical items are items that contact mucous membranes (e.g., eyes, nose, or mouth) or non-intact skin. At a minimum, semicritical items require high-level disinfection using chemical disinfectants and rinsing with sterile water. Examples include respiratory therapy and anesthesia equipment, some endoscopes, cystoscopes, and laryngoscope blades.

3) Noncritical items are items that have contact with intact skin but not mucous membranes and are associated with little risk of spreading germs. Noncritical items require at least low-level disinfection. Noncritical care items include bedpans, blood pressure cuffs, blood glucometers, crutches, and computers. Noncritical environmental surfaces include bed rails, tray tables, bedside tables, walls, floors, toilets, sinks, and furniture.


Tools and Resources

Ambulatory surgical centers

Checklists for monitoring compliance with cleaning practices

Environmental Protection Agency (EPA)

Fact sheets

Guidelines for Environmental Infection Control in Healthcare Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).  June 6, 2003. MMWR.

Indiana State Department of Health HAI Prevention Education Module – Course 1: Environmental Cleaning

Not Just a Maid Service – Film developed by the Illinois Department of Public Health and the Illinois Quality Improvement Organization that highlights the role of environmental service workers in the prevention ofClostridium difficile infection.

Rutala WA, Weber DJ, et al., and the Healthcare Infection Control Practices Advisory Committee (HICPAC).Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.

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Cleaning of equipment

Coming soon

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Appropriate patient/resident placement

Prioritize for placement in a single-patient/resident room if the patient/resident is at increased risk of transmission, is likely to contaminate the environment, does not maintain appropriate hand hygiene, or is at increased risk of acquiring infection or developing adverse outcome following infection.

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Handling of textiles/laundry

Handle in a manner that prevents transfer of microorganisms to others and to the environment.

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Safe injection practices

Implementing safe injection practices, monitoring blood glucose appropriately, and following the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard help prevent the transmission of bloodborne pathogens such as HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) in healthcare and residential settings.

  • Do not recap, bend, break, or hand-manipulate used needles.
  • Use safety features when available.
  • Place used sharps in a puncture-resistant container.
  • Use a surgical mask for insertion of catheters or injection of material into spinal or epidural spaces via lumbar puncture procedures (e.g., myelogram, spinal or epidural anesthesia).

Safe injection practices are a set of infection prevention recommendations intended to prevent transmission of infectious diseases between one patient/resident and another or between a patient/resident and care provider and to prevent injuries, such as needle sticks.  Because we do not always know if a person has an infectious disease, safe injection practices are a part of standard precautions that are applied to every person every time to assure that injections are performed in a way that is safe and healthy for the patient/resident, care provider, and community.  A safe injection does not harm the recipient, does not expose the care provider to any avoidable risks, and does not result in waste that is dangerous for the community.  To follow safe injection practices, care providers should implement these recommendations:

  • Use aseptic technique to avoid contamination of sterile injection equipment.
  • Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed.
    • Needles, cannulae, and syringes are sterile, single-use items; they should not be reused for another patient.
  • Use fluid infusion and administration sets (i.e., intravenous bags, tubing, and connectors) for one patient only and dispose appropriately after use. Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient’s intravenous infusion bag or administration set.
  • Use single-dose vials for parenteral medications whenever possible.
  • Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use.
  • If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile.
  • Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer’s recommendations; discard if sterility is compromised or questionable.
  • Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients.

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Respiratory hygiene/cough etiquette

  • Maintain spatial separation (at least 3 feet) or wear a surgical mask, if the person is able to tolerate it.
  • Cover mouth/nose when coughing/sneezing.
  • Use tissues and promptly dispose of them in trash.
  • Perform hand hygiene after soiling hands with respiratory secretions.

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Patient Resources

This page contains a variety of resources for patients, family members, and patient advocates to protect themselves from getting infections, to get fact sheets and educational guides on several HAIs and infection prevention related topics, to learn more about nonprofit organizations and national campaigns dedicated to consumers and HAI prevention, and to help choose a healthcare provider.

Ways for Patients and Family Members to Prevent Infection

Healthcare-associated infections require multiple approaches for prevention. However, everyone can reduce the risk of getting a healthcare-associated infection, and reduce the risk of infecting others, by taking the following steps:

1. Keep hands clean

  • Perform hand hygiene, which means washing your hands regularly with soap and water or using an alcohol-based hand rub.  Learn the specific times when you should only use soap and water.
  • Make sure that healthcare providers clean their hands too.  Doctors, nurses, dentists, and other people who care for you come into contact with lots of bacteria and viruses.  So before they treat you, politely ask them if they have cleaned their hands.
    • Don’t be afraid to ask care providers if they should wear gloves, especially if they will be performing tasks such as taking blood or touching wounds or other body openings.
  • Remind your visitors to clean their hands before and after their visit and throughout their visit, as appropriate.

2. Understand your care (or your loved ones' care).

  • Ask your healthcare provider to explain the condition or procedure carefully, as well as any possible complications.
  • Ask your healthcare provider what specific steps he/she takes to prevent infections as well as what you can do to prevent infections before, during, and after your visit as it applies to your care.

3. Be a good visitor

  • This includes staying home if you are sick, following special precautions if necessary (such as wearing a mask or other protective clothing), checking first before bringing food, flowers, or young visitors, and sneezing and coughing into your elbow, not your hand.

4. Protect your skin.

  • It is important to take good care of your skin because it’s the body’s first line of defense against infection.
  • If you have wounds or cuts, make sure the bandages are changed regularly, and follow your healthcare provider's instructions on proper care of the wound.

5. If you have a drain or catheter (a tube that can be inserted into a body cavity, duct, or vessel):

  • Ask your doctor or other healthcare provider to explain why you need the catheter or drain and what you should do to avoid infection.
  • Follow instructions for the care of the catheter or drain to keep it working as it should and to keep it clean and free of germs.
  • Check the catheter or drain often.  If the bandage becomes wet or dirty, or the catheter or drain falls out, tell your healthcare provider.
  • Work with your healthcare provider to make sure that the catheter or drain is removed as soon as it is no longer medically needed.

6. Do not share personal items.

  • Avoid sharing personal items such as towels, washcloths, razors, clothing, blood glucose monitors, etc. with others because people may not always show symptoms if they are carrying infectious germs.

7. Cover your mouth and nose when you cough or sneeze and encourage others to do the same.

  • When you sneeze or cough, the germs can travel 3 feet or more!
  • Use a tissue and perform hand hygiene every time after coughing or sneezing.
  • No tissue? Cover your mouth and nose with the bend of your elbow. If you use your hands, clean them right away.

8. Avoid touching your eyes, nose, and mouth as much as possible. Germs spread that way.

9. If you are sick, avoid close contact with others.

  • Stay home.  Generally, people should stay home from work or school until at least 24 hours after they no longer have a fever (without the use of fever-reducing medicines such as acetaminophen).
  • Don't shake hands or touch others.  Increase the number of times you perform hand hygiene.
  • When you visit a healthcare provider, call ahead and let them know you are ill. Healthcare providers might ask you to take extra precautions (such as wearing a mask) before entering the facility and while you are in the waiting room to further protect yourself and others.

10. Get shots to avoid disease and prevent the spread of infection

  • Know which shots are taken every year (like the flu shot) and which provide long-term immunity.
  • Make sure you are up-to-date on your vaccinations by checking with your healthcare provider.

11. Choose a healthcare facility that is licensed by the Virginia Department of Health and accredited by national healthcare organizations.


Patient Education Guides / Fact Sheets

VDH-developed fact sheets (FAQs) for patients, family members, and visitors

General settings

Long-term care settings (nursing homes and assisted living facilities) 

  • Indiana State Department of Health HAI Prevention Educational Module: What are Healthcare-Associated Infections? – interactive online course for patients, caregivers, and family members introducing what HAIs are and how to prevent them
  • SHEA (Society for Healthcare Epidemiology of America) – provides patient education guides on seven common HAIs including: surgical site infection (SSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), Clostridium difficile infection (CDI), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE).
  • Tips for Preventing Infection Following Surgery – simple tips for patients and family members to follow after surgery and before leaving the healthcare facility to help lower the risk of infection.

Patient Advocacy Resources

  • National campaigns/organizations
    • AHRQ (Agency for Healthcare Research & Quality)
    • APIC (Association for Professionals in Infection Control and Epidemiology)
    • CDC (Centers for Disease Control and Prevention)
    • HHS (Department of Health and Human Services)
      • Do the “WAVE” – campaign that encourages healthcare consumers to Wash or clean hands, Ask healthcare providers questions, Vaccinate, and Ensure safety of medical equipment.
      • Partnering to Heal– computer-based, video-simulation training program on infection control practices that highlights the importance of effective communication and ideas for creating a “culture of safety” in healthcare facilities to keep patients from getting sicker.
    • The Joint Commission
      • Speak Up – campaign that urges patients to take a role in preventing health care errors by becoming active, involved, and informed participants on the health care team.  Features brochures, posters, and videos on a variety of patient safety topics. Some products are tailored to the specific healthcare setting (e.g., hospital, ambulatory care, long-term care, home health, etc.)
    • VA (Department of Veterans Affairs)
      • Infection: Don’t Pass It On – campaign to involve VA staff, Veterans, their families and visitors in preventing the transmission of infection.
  • Nonprofit organizations
    • CDC Foundation – connects the CDC with private-sector organizations and individuals to build public health programs to improve health and safety.
      • February 2014 issue of Business Pulse focuses on safe healthcare and HAI prevention. Discusses how projects and resources from the CDC and states can help safeguard businesses and employees from infections and lower business costs.
      • Infographic on safe healthcare
    • Consumers Advancing Patient Safety (CAPS) – a consumer-led, nonprofit organization formed to be a collective voice for individuals, families, and healers who wish to prevent harm in healthcare encounters. Provides free access to resources, tools and education materials, and consumer engagement toolkits.
    • Empowered Patient Coalition – an organization created by patient advocates to provide information and education to support patient empowerment and patient safety efforts.
    • National Patient Safety Foundation – organization dedicated to improving the safety of care provided to patients.
    • Safe Care Campaign – an organization created to help educate patients about how they may help prevent infection while receiving medical care.
    • Safe Patient Project - a campaign of Consumers Union that seeks to eliminate medical harm in the health care system through public disclosure of health care outcomes and information about medical care providers.

Resources for Choosing a Provider

  • Centers for Medicare and Medicaid Services Guide to Choosing a Hospital – a booklet that explains steps to find and compare hospitals, why hospital quality is important, and provides information about Medicare and hospital stays
  • Consumers Union – a testing and information organization serving only consumers.  Publishes Consumer Reports magazine, which has featured articles on HAIs including state-specific infection data.
  • Dialysis Compare – a searchable database of dialysis providers that permits the user to compare facilities on a variety of quality measures and other facility characteristics.
  • Hospital Compare – a searchable database of hospital providers that permits the user to compare facilities on a variety of quality measures, including hospital-acquired conditions and serious complications and deaths.
  • The Leapfrog Group – a resource that presents data from the Leapfrog Hospital Survey, a voluntary survey of hospitals, that permits the user to compare facilities by overall patient safety ratings or by safety of selected procedures
  • Nursing Home Compare – a searchable database of Medicare and Medicaid-certified nursing homes that permits the user to compare facilities on a variety of quality measures and other facility characteristics.
  • Virginia Department of Health Healthcare-Associated Infections (HAIs) Central Line-Associated Bloodstream Infection Reports
  • Virginia Health Information – a nonprofit, health data organization that develops and implements health data projects to supply useful information to consumers and purchasers of healthcare, health plans, and healthcare facilities. Provides resources on cost, quality, and efficiency of healthcare facilities in Virginia. Also contains consumer guides for various levels of care. Serves as a Patient Safety Organization.

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There are three types of transmission-based precautions: contact precautions (for diseases spread by direct or indirect contact), droplet precautions (for diseases spread by large particles in the air), and airborne precautions (for diseases spread by small particles in the air).  Each type of precautions has some unique prevention steps that should be taken, but all have standard precautions as their foundation.

Contact Precautions

  • Used for patients/residents that have an infection that can be spread by contact with the person’s skin, mucous membranes, feces, vomit, urine, wound drainage, or other body fluids, or by contact with equipment or environmental surfaces that may be contaminated by the patient/resident or by his/her secretions and excretions.
  • Examples of infections/conditions that require contact precautions: Salmonella, scabies, Shigella, and pressure ulcers.
  • In addition to standard precautions:
    • Wear a gown and gloves upon room entry of a patient/resident on contact precautions.
    • Use disposable single-use or patient/resident-dedicated noncritical care equipment (such as blood pressure cuffs and stethoscopes).
  • For certain organisms likely to have spores (like Clostridium difficile) and some disease with ongoing transmission (like Norovirus), “special” contact precautions are needed. In addition to the measures above, perform hand hygiene using soap and water and consider use of a hypochlorite solution (e.g., bleach) for environmental cleaning.

Droplet Precautions

  • Used for patients/residents that have an infection that can be spread through close respiratory or mucous membrane contact with respiratory secretions.
  • Examples of infections/conditions that require droplet precautions:  influenza, N. meningitidis (one of the causes of meningitis), pertussis (also known as “whooping cough”), and rhinovirus (also known as the “common cold”).
  •  In addition to standard precautions:
    • Wear a mask upon room entry of a patient/resident on droplet precautions.
  • A single patient/resident room is preferred. If not available, spatial separation of more than 3 feet and drawing the curtain between beds is especially important.
  • Patients/residents on droplet precautions who must be transported outside of the room should wear a mask if tolerated and follow respiratory hygiene/cough etiquette.

Airborne Precautions

  • Used for patients/residents that have an infection that can be spread over long distances when suspended in the air. These disease particles are very small and require special respiratory protection and room ventilation.
  • Examples of infections/conditions that require airborne precautions: chickenpox, measles, and tuberculosis.
  • In addition to standard precautions:
    • Wear a mask or respirator prior to room entry, depending on the disease-specific recommendations. Most diseases will require N95 or higher respiratory protection.
    • Place patient/resident in an airborne infection isolation (AII) room – a single-person room that is equipped with special air handing and ventilation capacity.
      • If the facility does not have an AII room, place the person in a private room with the door closed until the person is transferred to another facility with an AII room.
  • When possible, non-immune healthcare workers should not care for patients/residents with vaccine preventable airborne diseases (like measles and chickenpox).

Ambulatory care settings provide healthcare on an outpatient basis. That is, patients do not stay overnight in the facility. The term "ambulatory care" encompasses a large variety of healthcare settings that include but are not limited to physician offices, urgent care centers, dialysis facilities, ambulatory surgical centers, cancer clinics, imaging centers, endoscopy clinics, public health clinics, and other types of outpatient clinics.


Special considerations for infection prevention in these settings:

  • This category covers a wide range of facilities, providing a variety of different medical care services and having a range of licensing requirements, staff training needs, and surveillance procedures.
    • For more information on licensure and certification, click here
  • The degree to which the infection prevention program is formalized may differ, but for each setting, infection prevention is a high priority. The infection prevention programs range, depending on the type of setting and licensing requirements, from policies established by the facility to accountability defined by the Centers for Medicare and Medicaid Services or another certifying organization.
  • Patients play an important role in preventing infections and in identifying any that might be associated with outpatient care. It is important to know the signs and symptoms of infection and contact your provider for follow up if any symptoms develop.
    • This is especially true for ambulatory care settings because the signs of an infection may not present until after the patient leaves the facility.

Reporting requirements

  • Virginia reportable disease list
    • Outlines diseases and conditions (including outbreaks) that are reportable to the local health department by physicians, directors of medical care facilities, and directors of laboratories.
  • In January 2012, the Centers for Medicare and Medicaid Services (CMS) began requiring dialysis facilities participating in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) to report certain infection events to the National Healthcare Safety Network (NHSN), including positive blood culture, I.V. antimicrobial start, and signs of vascular access infection. In January 2015, CMS added summary-level healthcare personnel influenza vaccination coverage rates to the ESRD reporting requirements.
  • In October 2014, CMS began requiring ambulatory surgery centers participating in the Ambulatory Surgery Centers Quality Reporting program to report summary-level influenza vaccination data for all healthcare personnel via NHSN.

Resources


Ambulatory surgical centers


Dialysis facilities


Other settings

Long-term care (LTC) facilities provide a variety of medical and non-medical services to people who have a chronic disease or disability. These settings may include but are not limited to: nursing homes (NH)/skilled nursing facilities, inpatient rehabilitation facilities, assisted living facilities (ALF), hospice, senior day care services, and long-term acute care hospitals.


Special considerations for infection prevention in these settings:

  • An increasing number of individuals in the United States is receiving care in LTC facilities. These residents have growing medical complexity and care needs, and increasing exposure to devices and antibiotics.
  • Patients/residents may transfer in and out of long-term care with some frequency, so appropriate communication of medical history, including antibiotic use, devices, past infections, and risk factors is critical.
  • Scientific literature on the prevalence of healthcare-associated infections (HAI) and evidence-based prevention practices in these settings is limited.
    • No standardized system for HAI surveillance has been adopted nationally.

VDH reports and projects


Reporting requirements

  • Virginia reportable disease list
    • Outlines diseases and conditions (including outbreaks) that are reportable to the local health department by physicians, directors of medical care facilities (such as nursing homes), and directors of laboratories.
    • Assisted living facilities are required to call the health department whenever they suspect an outbreak may be occurring but are not required to report individual cases of the reportable diseases/conditions. If an ALF resident has a reportable disease/condition, his/her physician is responsible for reporting to the local health department.
    • Part of the Regulations for Disease Reporting and Control

Successful Strategies for the Prevention of Urinary Tract Infections in Long-Term Care TOOLKIT (Fall 2011)

This toolkit compiles UTI definitions, regulations, tools, policy templates, educational resources, and presentations addressing appropriate management and treatment in long-term care settings.  It also incorporates related material from Successful Strategies for Infection Prevention and Control in Assisted Living Facilities and Nursing Homes TOOLKIT.


Successful Strategies for Infection Prevention and Control in Assisted Living Facilities and Nursing Homes TOOLKIT

This toolkit contains infection prevention presentations, resources, and tools that have been adapted for the assisted living facility (ALF) and nursing home (NH) setting whenever possible.  The toolkit has been made available to ALFs, NHs, local health departments, and licensing agencies in the Commonwealth of Virginia.

These documents have been developed from published evidence-based research, standards of practice, or recommendations obtained from the Centers for Disease Control and Prevention (CDC), Healthcare Infection Control Practices Advisory Committee (HICPAC), Occupational Safety and Health Administration (OSHA), Centers for Medicare and Medicaid Services (CMS), licensing agencies, professional organizations, or other recognized sources.

How to Use: These documents are meant to supplement the Successful Strategies for Infection Prevention in Assisted Living Facilities and Nursing Homes training and may be adapted for use in your facility.  Resources were copied onto DVDs and shared so that facility staff may make copies, use materials to provide education to others, and customize tools as necessary.  If a document is not available in a version that is editable but you wish to customize it, please contact the VDH HAI Program for help. Most fact sheets and guidelines are dated within the document. Other signs, templates, and Powerpoint presentations produced by VDH or other agencies have the date of production italicized in parentheses next to the name.

The toolkit is meant to introduce and summarize, and does not replace published standards and regulations.  Refer to the toolkit component, “Infection Prevention Resources and Guidelines for Assisted Living Facilities and Nursing Homes”, to help access additional documents and contact your local health department or the VDH HAI Program with questions.

Individual toolkit components can be downloaded below.

Introduction

Presentations

Summary documents

Infection transmission

Bloodborne pathogen (BBP) transmission and blood glucose monitoring (BGM)

Hand hygiene (HH) and personal protective equipment (PPE)

Environmental cleaning

Vaccination

Prevention strategies

Surveillance

Influenza

  • For fact sheets, signs, prevention guidelines, and other materials on influenza, click here to access influenza educational resources for long-term care facilities (including assisted living facilities)

Gastrointestinal illnesses

Other diseases/conditions

Tuberculosis

Urinary tract infections

Guidance documents


Other resources


Vaccination Information for Infection Preventionists


Overview

Vaccination is a key infection prevention tool for healthcare workers as well as patients entering healthcare facilities. Patients may be at greater risk for serious infections and complications from vaccine-preventable diseases due to age, weakened immune systems, or underlying health conditions. It is important to encourage staff members, patients, visitors, and family members to get vaccinated to protect themselves from disease and help prevent the spread of disease within healthcare facilities as well as in the community.

For detailed information on vaccinations in healthcare settings, please visit the Division of Immunization’s healthcare webpage.

Best Practices for Healthcare Settings

Care providers in healthcare facilities may be at risk for exposure to and transmission of vaccine-preventable diseases.  Maintenance of immunity is an essential part of prevention.

Suggested strategies include:

  • Learn about the different vaccines recommended for care providers in your setting
  • Maintain your own individual vaccination record
  • Help your facility keep accurate and up-to-date patient and employee vaccination records
  • Familiarize yourself with the child/adolescent and adult vaccination schedule recommendations (revised annually) and procedures for administration
  • Get involved with influenza vaccination campaigns each year to encourage coworkers to protect themselves and their patients

Regulations

  • Federal regulations (Occupational Safety and Health Administration’s Bloodborne Pathogen Standard 1910.1030) and state regulations (16VAC25-90-1910) require that employers comply with the OSHA Bloodborne Pathogens Standard. One of the requirements of this standard is that employees who have occupational exposure to blood or other infectious materials be offered the hepatitis B vaccination series by the employer at no cost unless the employee has previously received the complete series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated (not recommended) for medical reasons. The vaccination series must be provided in accordance with the recommendations of the U.S. Public Health Service current at the time of the vaccination. This includes follow-up testing one to two months after the completion of the three-dose vaccination series to test for antibody to hepatitis B surface antigen.
  • State regulations (12 VAC5-371-110) require nursing homes to provide or arrange for the administration of a pneumococcal vaccination and an annual influenza vaccination according to the most recent recommendations unless the vaccination is contraindicated or the resident declines the vaccination offer.

Vaccine Recommendations


Resources

Advisory Committee on Immunization Practices (ACIP) – a group of experts in fields associated with immunization that provides advice and guidance to governmental agencies on the control of vaccine-preventable diseases. This group develops written recommendations for the routine administration of vaccines to children and adults, including age for vaccine administration, number of doses and dosing interval (how long between doses), and precautions and contraindications.

Bolyard EA, Tablan OC, Williams WW, Pearson ML, Shapiro CN, Deitchman SD, and the Healthcare Infection Control Practices Advisory Committee (HICPAC).  Guideline for Infection Control in Healthcare Personnel, 1998.

Immunization Action Coalition – a non-profit organization that works to increase immunization rates and prevent disease by creating and distributing educational materials for health professionals and the public.

Vaccination FAQ (for assisted living facilities and nursing homes)

Vaccination FAQ (for other healthcare settings)

For detailed information regarding recommended vaccinations, vaccination coverage data, vaccination procedures, or other information, please visit the Virginia Department of Health’s Division of Immunization at http://www.vdh.virginia.gov/immunization/ or call the Division at 1-800-568-1929.


Bloodborne Pathogens


Overview

A bloodborne pathogen (BBP) is a type of bacteria or virus that is spread by contact with an infected individual’s blood or other potentially infectious body fluids. Examples of diseases caused by bloodborne pathogens include human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).

The most common ways a person can be exposed to a bloodborne pathogen include receiving contaminated blood or blood products, sharing needles (includes needles used during tattooing or body piercing), or having unprotected sexual intercourse. In a healthcare or residential setting, exposure may also occur as a result of unsafe injection practices or through contact with contaminated equipment such as blood glucose monitoring devices, podiatry equipment, or any other device that has not been properly cleaned and disinfected.

Estimated burden of bloodborne infections in healthcare facilities in the United States:

  • Between 1998 and 2008, there were 40 outbreaks of HBV or HCV in healthcare settings
    • 33 of these outbreaks occurred in non-hospital healthcare settings (15 in long-term care facilities, 12 in outpatient clinics, and 6 in hemodialysis centers), resulting in 448 persons acquiring HBV or HCV infection. (citation)
  • An additional 11 outbreaks of healthcare-associated HBV or HCV occurred in 10 states between July 2008 and June 2009, resulting in at least 120 persons acquiring HBV or HCV infection. (citation)
    • 9 of these outbreaks occurred in non-hospital healthcare settings.
  • In the last 10 years, there have been at least 15 outbreaks of HBV infection associated with providers failing to follow standard principles of infection control when assisting with blood glucose monitoring. (citation)
  • Transmission of HIV to patients while in healthcare settings is rare. Most exposures do not result in infection.
    • The risk of HIV transmission to a healthcare worker after percutaneous exposure to HIV-infected blood is considerably lower than the risk of HBV transmission after percutaneous exposure to blood that is positive for HBV (0.3% versus approximately 30%). (citation)
    • Between 1981 and 2010, 57 healthcare personnel had documented seroconversion to HIV following occupational exposure. (citation)
  • Bloodborne pathogen transmission events often result in facility closures and large public health notifications of hundreds or thousands of potentially exposed patients.


Tools and Resources


Safe Blood Glucose Monitoring (BGM)

To prevent the transmission of bloodborne pathogens when assisting patients or residents with BGM, care providers should:

  • Always perform hand hygiene and use new gloves before conducting BGM and between each person tested.
  • Use a single-use lancet to prick the skin.  Restrict use of penlet devices to individuals who do not require assistance with BGM.
  • NEVER share fingerstick devices between persons.
  • NEVER use insulin pens and other medication cartridges and syringes for more than one person; they are for single-patient use only.
  • When possible, assign blood glucose monitors to an individual person.  If sharing is necessary, clean and disinfect the monitor after every use according to the manufacturer’s instructions.  If the manufacturer does not specify how the device should be cleaned and disinfected, then it should not be shared.
  • Dispose of used lancets in an approved sharps container and empty container appropriately.

OSHA Bloodborne Pathogens (BBP) Standard

This federal regulation describes the policies and practices that employers must establish to protect employees who may have contact with blood or other potentially infectious materials while performing their job duties. The Virginia Occupational Safety and Health (VOSH) Program has adopted the federal OSHA standard and has incorporated it by reference into the Virginia Administrative Code (16VAC25-90-1910). The strategies outlined in the OSHA BBP Standard that can reduce the risk of infection on the job include:

  • Exposure control plan – document that describes how the employer will address the parts of the Bloodborne Pathogens Standard.
  • Engineering controls – systems or mechanical devices that minimize hazards in the workplace, such as sharps disposal containers.
  • Work practice controls – practices that reduce the possibility of exposure by changing the way a task is performed, such as appropriate practices for hand hygiene and handling laundry.
  • Standard precautions – a set of measures designed to protect staff and patients or residents from exposure to disease that should be applied all the time for all patients and residents.  Includes personal protective equipment, or protective wear that serves as a barrier between a person and the blood/body fluids of another person.
  • Housekeeping – Facility should have a regular cleaning schedule and procedures for cleaning and disinfecting all areas of the facility as well as a plan to manage blood spills.
  • Hepatitis B vaccine – Employers should offer the hepatitis B vaccination series at no cost to all employees covered under the OSHA BBP Standard, within 10 working days of initial assignment, after appropriate training has been completed, unless the worker has previously received the vaccine series, antibody testing has revealed the worker is immune, or the vaccine is contraindicated (not recommended) for medical reasons. The vaccination series must be provided in accordance with the recommendations of the U.S. Public Health Service current at the time of the vaccination. This includes follow-up testing one to two months after the completion of the three-dose vaccination series to test for antibody to hepatitis B surface antigen.
  • Occupational exposure follow-up, training, and record keeping – exposures to blood or body fluids should be reported and follow-up care provided.  Training in the BBP Standard is required upon hire and annually.  A sharps injury log must be maintained and medical records kept for a specified amount of time.

Bloodborne Pathogens General resources

  • One Needle, One Syringe, Only One Time. Safe Injection Practices Coalition.The One & Only Campaign – a public health campaign, led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices.
  • Healthcare Provider Toolkit – assists individuals and organizations with educating healthcare providers and patients about safe injection practices. Includes a narrated PowerPoint presentation, a no-cost Medscape CME activity, multimedia materials, print materials (posters, brochures, pocket cards, etc.), guidelines, position statements, and peer-reviewed published articles. Toolkit can be ordered free of charge.
  • State/Local Health Department Toolkit – provides health departments with the background and information to implement the One & Only Campaign.

Facility-specific resources 


Other Healthcare Resources

Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard – federal regulation that states what employers must do to protect workers who may be occupationally exposed to blood or other potentially infectious materials.

NHSN Healthcare Safety Personnel Module – click on the appropriate healthcare setting and select the “Surveillance for Healthcare Personnel Exposure” link to access the training, protocols, forms, analysis resources, and other support materials that can be used to help healthcare facilities track information about occupational exposures to blood and body fluids and their management.One Needle, One Syringe, Only One Time. Safe Injection Practices Coalition.

The One & Only Campaign - a public health campaign, led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices.

BBP Fact Sheets for Long-Term Care Settings (updated 7/5/17)

For additional prevention materials on safe injection practices and blood glucose monitoring such as posters, policy templates, or sample in-services for healthcare or residential facilities, please see Safe Injection Practices

For more information about hepatitis in healthcare settings, see the CDC hepatitis website.

For more information about HIV in healthcare settings, see the CDC HIV website.


Citation:
Thompson ND, Perz JF, Moorman AC, and Holmberg SD. Nonhospital Health Care-Associated Hepatitis B and C Virus Transmission: United States, 1998-2008. Annals of Internal Medicine. 2009;150:33-39.